Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2012
Review[Fluid management: estimation of fluid status].
Cardiac filling pressures alone are not appropriate to estimate the effect of a volume challenge on the corresponding change in stroke volume. Dynamic variables of fluid responsiveness have been shown to discriminate with acceptable sensitivity and specificity between responders and non-responders to a volume challenge. However, several clinical confounders have been indentified which potentially influence the predictive power of these variables. Sound knowledge of these confounders and the acknowledgement that there is no unique threshold value for volume optimisation but a considerable "gray zone" is necessary to fully exploit the advantages of functional haemodynamic monitoring.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2012
Review[Multimodal pain therapy - implementation of process management - an attempt to consider management approaches].
The combination of medical and economical proceedings allows new perspectives in the illustration of medical workflows. Considering structural and developmental aspects multimodal therapy programs show similarities with typical subjects of economic process systems. By pointing out the strategic appearance of the multimodal pain therapy concept multimodal approaches can be described to some extent by using management approaches. E. g., an economic process landscape can be used to represent procedures of a multimodal pain therapy program.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2012
Review[Anesthesia in endoscopic and percutaneous procedures in cardio-thoracic and cardiovascular interventions, Part 1-- percutaneous aortic valve replacement and mitral valve repair].
Further development of surgical techniques and instruments provide complex endoscopic or transcatheter guided interventions in thoracic organs. However, minimalinvasive surgery does not mean minimalinvasive anaesthesia. ⋯ Considering the surgical procedures, this review describes the anaesthesiological management for transcatheter aortic valve implantation (TAVI) and percutaneous mitral valve repair. Furthermore it focuses on the anaesthesiological management of pitfalls and complications related to the surgical procedure.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2012
Review[Fluid management: goal-directed therapy].
Goal-directed fluid therapy (GDT) is one important step in perioperative therapy as it improves complication rate and mortality by optimisation of oxygen delivery. There is a convincing evidence for GDT when used early, before organ failure occurs, and in high-risk patients. Moderne algorithms use goals derived from advanced haemodynamic monitoring and are based on the concept of fluid responsiveness and optimisation of global perfusion. Future investigations will have to prove the advantage of using the new less or non-invasive haemodynamic monitoring devices or automatic closed-loop fluid administration systems for GDT.